卵巢良性囊肿手术对体外受精-胚胎移植妊娠结局的影响

Effect of Ovarian Benign Cyst Surgery on Pregnancy Outcome of in Vitro Fertilization-Embryo Transfer

目的 分析卵巢良性囊肿手术的实施对体外受精-胚胎移植妊娠结局的影响。 方法 选取2015年3月至2018年5月于宝鸡市中心医院妇科确诊为卵巢良性囊肿且不孕的患者204例,将102例囊肿剥除术后接受体外受精-胚胎移植的患者作为研究组,其他102例未剥除囊肿开展体外受精-胚胎移植的患者作为对照组,对比两组体外受精-胚胎妊娠相关指标水平,包括卵泡刺激素(FSH)表达、人绒毛膜促性腺激素(HCG)日直径≥14 mm的卵泡数量、获得卵泡数量、抗苗勒管激素(AMH)表达、窦卵泡计数(AFC)、促性腺激素释放激素激动剂(GnRH-a)、促性腺激素(Gn)天数、Gn总量、胚胎移植数量、冷冻胚胎数量等,同时记录并对比两组患者的临床妊娠情况,包括周期取消率、临床妊娠率、流产率等。 结果 研究组基础FSH水平高于对照组[(6.59±3.01) U/L比(5.68± 2.19) U/L ]( P < 0.05 ),HCG日直径≥14 mm的卵泡数量、获得卵泡数量、AFC、AMH表达、胚胎移植数量、冷冻胚胎数量低于对照组( P <0.05);其他相关指标比较差异无统计学意义( P >0.05);周期取消率、临床妊娠率、流产率比较差异无统计学意义( P >0.05)。卵巢子宫内膜异位囊肿组AFC较其他囊肿组减少、AMH降低、冷冻胚胎数量减少( P <0.05);组间年龄、基础FSH、Gn天数、Gn总量比较差异无统计学意义( P >0.05);卵巢子宫内膜异位囊肿组临床妊娠率、流产率与其他囊肿组比较差异无统计学意义( P >0.05)。 结论 卵巢良性囊肿剥除术的实施在一定程度上可使女性卵巢储备功能降低,体外受精-胚胎移植获卵数及冷冻胚胎数减少,尤以卵巢子宫内膜异位囊肿患者所受影响更大,但并不会对患者胚胎移植临床妊娠率产生较大影响。

Objective To analyze the effect of ovarian benign cyst surgery on pregnancy outcome of in vitro fertilization-embryo transfer (IVF-ET). Methods 204 infertility patients who were diagnosed with ovarian benign cyst in the Baoji central Hospital from Mar. 2015 to May 2018 were selected.102 patients with IVF-ET after cystectomy were selected as research group,and 102 patients with IVF-ET but without cystectomy were taken as control group.The levels of IVF-ET indexes in the two groups were compared,including expression of follicle-stimulating hormone (FSH),number of follicle diameter ≥14 mm on the day of human chorionic gonadotropin (HCG),number of retrieved oocytes,expression of anti-Müllerian hormone (AMH),antral follicle count (AFC),gonadotropin releasing hormone agonist (GnRH-a),gonadotropin (Gn) days,total Gn,number of embryo transfer,number of frozen embryo.The clinical pregnancy conditions such as the cycle cancellation rate,clinical pregnancy rate,abortion rate were recorded and compared between the two groups. Results The level of basic FSH in research group was higher than that in control group[(6.59±3.01) U/L vs (5.68±2.19) U/L], the number of follicle diameter≥14 mm on the day of HCG in research group was less than that in control group,the number of retrieved oocytes in research group was less than that in control group,the AFC in research group was less than that in control group,the expression of AMH in research group was lower than that in control group,the number of embryo transfer in research group was less than that in control group,and the number of frozen embryo in research group was less than that in control group ( P <0.05);There was no statistical difference in the other indexes between the two groups ( P >0.05);There was no statistical difference in the cycle cancellation rate,clinical pregnancy rate,abortion rate between the two groups ( P >0.05).The AFC in endometriotic cyst group was less than that in other cyst group,the AMH in endometriotic cyst group decreased,and the number of frozen embryo in endometriotic cyst group reduced ( P <0.05);There was no statistical difference in the age,basic FSH,Gn days,total Gn between the two groups ( P >0.05);The clinical pregnancy rate of endometriotic cyst group was slightly lower than that of other cyst group,and the abortion rate of endometriotic cyst group was slightly higher than that of other cyst group,but there was no statistical difference between the two groups ( P >0.05). Conclusion Ovarian benign cyst scystectomy may decrease the female ovarian reserve function to a certain extent,reduce the number of retrieved oocytes in IVF-ET and the number of frozen embryo,the patients with endometriotic cyst are even more affected,but it will not have a significant impact on the clinical pregnancy rate of patients with embryo transfer.